ameslee
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Posts:5
Hi,
I have a question about pseudo-progression on immunotherapy. I was told that if scans look worse but the patient feels better, then there's a chance that the scan is showing pseudo-progression instead of true progression. Does pseudo-progression mean that the tumor mass is actually bigger, potentially causing problems such as pain or blockage. Or does it mean that it looks enlarged but is actually not enlarged (an illusion on the scan)? So if an enlarged tumor due to pseudo-progression is pressing on a nerve or causing other problems, how would a patient be expected to feel better?
Thank you for your time.
Ameslee
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Reply # - March 5, 2015, 04:38 PM
First, it's worth noting that
First, it's worth noting that pseudoprogression is possible but not common (<10% of patients). Most of the time, when things look worse on scans, it's because the cancer is progressing. However, sometimes with immunotherapies, one or more lesions is actually bigger because host (patient) immune cells (T cells) are attacking the tumor cells. So while there are more cells, it's not actually more tumor. Here's a picture representation:
While I suppose it's theoretically possible for the influx of host immune cells to cause local problems, I've never heard of that. Immune cells probably wouldn't have the same tendency to invade or displace normal tissues that tumor cells will. Pseudoprogression has really been described in the setting of patients feeling and doing better, but the scan appears inexplicably worse.
You can read more here:
http://oncology.jamanetwork.com/article.aspx?articleid=2174768
Good luck.
-Dr. West